Failure to Provide Nail Care to Dependent Resident
Penalty
Summary
A deficiency was identified when a resident who required assistance with activities of daily living (ADLs) was observed to have long and dirty fingernails with black matter underneath. The resident was alert and responsive in Spanish, but required substantial to maximal assistance with personal hygiene, as documented in the MDS assessment. The wound care nurse confirmed that the resident was confused and dependent on staff for ADLs and transfers. The CNA was identified as responsible for providing nail care as part of the ADL program, but this care was not provided as evidenced by the resident's unclean nails. The resident's medical history included altered mental status, dependence on renal dialysis, end stage renal disease (ESRD), and chronic obstructive pulmonary disease (COPD). The comprehensive care plan indicated a self-care performance deficit related to activity intolerance due to ESRD, hemodialysis, and COPD. Facility policy required that residents unable to perform ADLs independently receive necessary services to maintain grooming and hygiene, including daily cleaning and regular trimming of fingernails. Despite these requirements, the resident did not receive appropriate nail care.